Initially, the client described the pain as stabbing rated 9/10. however, after administering 2 SL Nitro and ASA 325 mg, the pain gradually became crampy and is currently rated 1/10. In addition, the client was also given Lasix 40 mg IV. The client reported that she tried Excedrin PM and Tylenol PM at home to relieve the pain but was unsuccessful. A day prior to consulting, the client related that she tried taking 100 mg of Toprol XL, which provided no pain relief. Carissa had a history of uncontrolled hypertension and was diagnosed with congestive heart failure (CHF), dilated cardiomyopathy, and polysubstance abuse. – The client had a history of longstanding hypertension and polysubstance abuse. – In March 2005, the client was diagnosed with stage II left intraductal breast carcinoma, metastatic with 1/14 left axillary lymph nodes. The client was S/P left mastectomy, chemotherapy, and XRT. She had a history of depression in the same year. – In July 2006, the client was diagnosed with congestive heart failure and dilated cardiomyopathy. – On 11/7/2006 – 16/7/2006, the client was admitted in the ward for 5 days after presenting to the ED with complaints of chest pains and SOB. During her admission, the client’s cardiac enzymes, electrolytes, Mg++ levels are all WNL. Her EKG showed normal sinus rhythm with LA enlargement, LVH, and a prolonged QT interval (.514 sec) but no dynamic changes worrisome for cardiac ischemia. CXR showed marked cardiomegaly with some pulmonary vascular congestion. An ECHO was performed during this time revealing LA dilation (5.0 cm) with LV size at the upper limit of normal, severe impairment of LV systolic function with a calculated biplane EF of 14%. The LV diastolic filling pattern was felt to be pseudonormal. It was during this time that RT was started on an aggressive 5 drug regimen for heart failure and recommended to follow up with a cardiologist at the Myers Park Heart Failure clinic. She has followed up with the Heart Failure clinic two times since July.

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